Healthcare Provider Details

I. General information

NPI: 1902026792
Provider Name (Legal Business Name): BRENDA CUCCHERINI PH.D., RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 VERMONT AVE NW
WASHINGTON DC
20420-0001
US

IV. Provider business mailing address

3226 DARDEN DR
WOODBRIDGE VA
22192-3337
US

V. Phone/Fax

Practice location:
  • Phone: 202-254-0277
  • Fax: 202-254-0460
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024037656
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: